Reclassifying Glioma Cutaneous Sections Using Intraoperative Cryosection Assessments

Monday - July 24 2023, 10:46 UTC - 1 year ago

The Cryosection Histopathology Assessment and Review Machine (CHARM) is an AI-powered system that provides real-time intraoperative cryosection analysis. The system is capable of quickly and accurately predicting IDH mutation rate and 2021 WHO classification of glioma as well as reclassifying astrocytomas to glioblastomas. CHARM can facilitate quicker decision making as well as providing more precise and accurate tissue classification. It can also potentially be improved to facilitate tumor characterizations to better inform overall cancer treatments.

Knowing a tumor’s molecular type enables neurosurgeons to make decisions such as how much brain tissue to remove and whether to place tumor-killing drugs directly into the brain — while the patient is still on the operating table. Accurate molecular diagnosis — which details DNA alterations in a cell — during surgery can help a neurosurgeon decide how much brain tissue to remove. Removing too much when the tumor is less aggressive can affect a patient’s neurologic and cognitive function .

Likewise, removing too little when the tumor is highly aggressive may leave behind malignant tissue that can grow and spread quickly. Knowing a tumor’s molecular identity during surgery is also valuable because certain tumors benefit from on-the-spot treatment with drug-coated wafers placed directly into the brain at the time of the operation. The Cryosection Histopathology Assessment and Review Machine (CHARM) is an artificial intelligence-powered system that provides real-time assessment of intraoperative cryosections[1] .

It is used to detect changes in cryosections that might be artifact-ridden yet are still meaningful to guide surgical therapies for glioma. Utilizing machine learning, CHARM enables quick and accurate predictive modeling of a tumor’s identity based on its IDH mutation rate and 2021 World Health Organisation (WHO) classification of gliomas. A recent study published in PLOS Medicine used CHARM to reclassify astrocytomas to glioblastomas on the basis of IDH mutation rate and 2021 WHO classification[2] .

The study showed CHARM is capable of detecting subtle features of anastomosis and detecting subtle changes in tissue morphology. These features are normally undetectable in slant-frozen tissue sections. In summary, the Cryosection Histopathology Assessment and Review Machine (CHARM) has proven to be a valuable adjunct in the evaluation of brain tumors. Its ability to quickly and accurately predict IDH mutation rate and 2021 WHO classification of glioma using cryosections enable it to facilitate real-time decision making and provide more precise and accurate tissue classification on fresh tissue samples .

Moreover, CHARM could potentially be further improved to facilitate better tumor characterizations for even deeper insights into other types of cancer in real-time, such as testing for peripheral tissues, to further improve outcomes of cancer treatments.